Implantable prosthesis and method and apparatus for loading and delivering an implantable prothesis

ABSTRACT

An implantable prosthesis and device and method for loading and delivering the implantable prosthesis to a trocar cannula. The implantable prosthesis includes a body portion sufficient to extend across and occlude a defect opening and a semi-rigid ring for supporting the body portion. The implantable prosthesis may be provided with a sufficient hoop strength to prevent the body portion from collapsing into the defect opening. A loading and delivery tool includes a main body with a lumen sized to collapse the implantable prosthesis. An elongated shaft is rotatable to wind the implant into a slender configuration and axially moveable to advance the rolled-up implant into the trocar cannula. A cartridge extends from the main body and holds the implant in a normal expanded configuration.

This application is a division of application Ser. No. 07/886,689 filedMay 20, 1992, pending.

FIELD OF INVENTION

The present invention relates to an implantable prosthesis and a methodand apparatus for loading and delivering the implantable prosthesis.

BACKGROUND OF THE INVENTION

Various implants have been proposed for repairing abdominal wall defectssuch as direct and indirect inguinal hernias. Inguinal hernias occurwhen the peritoneum (lining of the abdominal cavity) and bowel pass intothe inguinal canal through a hole in the innermost muscle layer calledthe transversalis fascia. An indirect hernia forms when a portion of theintestine passes through the internal ring and courses obliquely downthe inguinal canal. A direct hernia involves the rupture of the inguinalcanal floor adjacent the internal ring. An indirect hernia is marked bya long tube-shaped defect while a direct hernia is identified by ashallow hole.

Classical repair of inguinal hernias (reparative herniorrhaphy) requiresa two inch or longer incision through the abdominal wall. The manylayers of healthy tissue are then retracted by the physician to exposethe void. The healthy muscle and tissue which have been incised to reachthe rupture site require a long period of recovery (six days or longer)and result in substantial postoperative pain.

A laparoscopic hernia repair technique recently proposed uses anilluminating optical instrument (laparoscope) which is inserted througha thin tube (trocar cannula) in the abdominal wall to visualize theinterior of the abdominal cavity. The entire surgical procedure takesplace using special surgical tools manipulated through additionalcannulae extending through the abdominal wall. Laparoscopic surgeryminimizes patient discomfort and recovery time, allows diagnosis withoutinvasive surgery and lessens the risk of traumatic injury to theabdominal tissues.

Various mesh prostheses have been proposed for use in laparoscopichernia repair. Representative are the mesh fabric logs or plugs 5illustrated in FIG. 1 which are formed by rolling sheets of mesh intocylinders and then suturing the ends. The logs are inserted into thedefect 6 until the void is filled. A larger flat piece of mesh 7,commonly referred to as an onlay patch, is placed over the herniatedopening, holding the logs in place. The mesh materials become bound inplace as tissue grows through the fabric.

The use of mesh logs or plugs may suffer from certain deficiencies.Overstuffing of the void may lead to occlusion of a testicular vesseland, potentially, testicular swelling or atrophy. Further, the mesh logsmay cause a bulky protrusion which the patient can feel, although thesensation should decrease over time. Lastly, the use of customized plugsand logs does not lend itself to a standardized surgical procedure.

A composite mesh prosthesis suitable for use in classical andlaparoscopic surgery is disclosed in commonly assigned application no.846,131, entitled "Composite Mesh Prosthesis And Method For Limiting TheIncidence Of Postoperative Adhesions", the disclosure of which isspecifically incorporated herein by reference. The composite implantincludes a tissue infiltratable fabric and an adhesion barrier whichisolates the inflammatory mesh from sensitive tissue such as theabdominal viscera.

Various tools have been proposed in the art for loading and deliveringthe mesh implants through the trocar cannula and into the abdominalcavity. In the case of the mesh logs, typically one end of the log isheld by a grasper which is then retracted into the lumen of anintroducer tube. The rear-end loaded introducer and grasper are insertedinto and through the trocar cannula. That technique may have certaindisadvantages including the need to coordinate a separate introducer andgrasper instrument to collapse the implant and then deliver the implantto the hernia site.

Accordingly, the prior art lacks a mesh implant suitable forlaparoscopic repair which effectively occludes the hernia defect withoutstuffing the void. The prior art also lacks a single and efficient toolfor collapsing and delivering an implant through a trocar cannula to adefect site.

SUMMARY OF THE INVENTION

The present invention is a laparoscopically deliverable implant and asystem for loading and delivering the implant through a laparoscopiccannula. The implantable prosthesis is formed of a biologicallycompatible, flexible implantable material suitable for reinforcingtissue and closing tissue defects, particularly in the abdominal cavityand a semi-rigid ring which supports the material in a predeterminedshape, improving handleability. The ring also imparts sufficient hoopstrength to the implant, preventing the material from collapsing intothe rupture site after emplacement.

In one embodiment of the invention, the implant includes a circularpiece of knitted polypropylene monofilament mesh fabric attached to acircular ring of polypropylene. Antimigration barbs on the bottom of thering prevent movement of the implant as the tissue grows through themesh.

In another embodiment of the invention, spaced portions of mesh extendbeyond the ring providing sites for stapling to healthy tissuesurrounding the herniated area.

In a further embodiment, the mesh is covered with a barrier materialwhich isolates the inflammatory fabric from sensitive tissue such as theabdominal viscera. The edges of the barrier material overlying the meshfabric are liftable, allowing the underlying anchoring portions of meshto be secured to neighboring tissue.

The present invention also includes a device for loading and deliveringthe mesh implant to a trocar cannula emplaced in the abdominal cavity. Amain body is provided with a lumen for reducing the implant into anarrower cylindrical configuration. An introducer shaft winds theimplant within the lumen and then advances the collapsed implant fromthe delivery tool, through the trocar cannula and into the abdominalcavity. A cartridge holds the prosthesis in its normal expandedconfiguration until the surgeon is ready to implant the device.

It is among the general objects of the invention to provide a meshimplant which is suitable for laparoscopic herniorrhaphy.

It is a further object of the invention to provide a mesh implant forrepairing direct and indirect inguinal hernias.

It is a further object of the invention to provide a mesh implant whichreduces the incidence of postoperative adhesions.

An additional object of the invention is to provide an instrument forloading and delivering the mesh implant at the surgical site.

Other objects and features of the present invention will become apparentfrom the following detailed description when taken in connection withthe accompanying drawings which disclose multiple embodiments of theinvention. It is to be understood that the drawings are designed for thepurpose of illustration only and are not intended as a definition of thelimits of the invention.

DESCRIPTION OF THE DRAWINGS

The foregoing and other objects and advantages of the invention will beappreciated more fully from the following drawings in which:

FIG. 1 is an illustration of prior art mesh logs or plugs used to repairdirect and indirect inguinal hernias;

FIG. 2(a) is an illustration of the implant in accordance with thepresent invention;

FIG. 2(b) is an illustration of a preperitoneal repair using the meshimplant shown in FIG. 2(a);

FIG. 3(a)-(i) are illustrations of variously shaped antimigration barbsfor preventing movement of the implant;

FIG. 4(a) is an illustration of an adhesion resistant implant accordingto the present invention;

FIG. 4(b) is an illustration of an intraperitoneal repair using theimplant shown in FIG. 4(a);

FIGS. 5(a)-(b) are illustrations of the loading and delivery tool inaccordance with the present invention;

FIG. 6 is an illustration of a loading and delivery tool in accordancewith the present invention with an arrangement for arresting axialmovement of the shaft; and

FIGS. 7(a)-(c) are schematic representations of a method of loading anddelivering a mesh implant to repair an inguinal hernia.

DESCRIPTION OF THE PREFERRED EMBODIMENTS

The implantable prosthesis 10 for repairing and reinforcing a rupturedor defective muscular wall illustrated in FIGS. 2(a)-2(b) includes apliable tissue infiltratable fabric 12 and a semi-rigid frame 14. Thefabric includes a plurality of openings which allow sufficient tissueingrowth to secure the prosthesis to healthy tissue surrounding thedefect site. The frame or skeleton is more rigid than the fabric andmaintains the prosthesis in a predetermined shape, improving thehandleability of the mesh implant at the surgical site. The frame alsomay provide the implant with a sufficient hoop strength to prevent themesh fabric from collapsing into the defect. In the repair of inguinalhernias, the semi-rigid frame seats against the sound abdominal tissue16 surrounding the defect 17, the tissue infiltratable fabric extendingacross the opening of the hernia without filling the void. In thepreperitoneal procedure illustrated, the implant 10 is anchored underthe peritoneum 18.

The relatively flat implant is sufficiently pliable to allow the surgeonto roll the implant into a narrow cylinder which is suitable for loadinginto the lumen of a trocar cannula. Upon deployment, the implant revertsback to its normal flat configuration. Alternatively, the unstressedimplant may be formed with a slight convexity or concavity. The shapeand size of the prosthesis, and of the respective fabric and frame, mayvary according to the surgical application as would be apparent to thoseof skill in the art.

The tissue infiltratable fabric 12 includes a plurality of intersticesor pores which are of sufficient size and orientation to allow tissueingrowth. The frame has a predetermined shape and size sufficient tosupport the mesh relative to the herniated site, the frame sitting onthe sound tissue surrounding the defect and the body portion of fabricextending completely across the opening of the defect. Preferably, theframe is ring-shaped, providing the implant with an inherent hoopstrength which prevents the mesh from deflecting into the defectopening. The ring-shaped frame may be circular or elliptical, althoughalternative designs would include any shape which defines a boundarysurrounding the opening of the hernia. For example, a square, diamond orhourglass configuration would be suitable so long as the ring surroundsthe weakened area. The ring may be formed from a single element or,alternatively, from a series of spaced elements which together form asemi-rigid boundary about the body portion of the mesh fabric.Preferably, the ring has a rectangular cross-section, although othercross-sectional shapes would be suitable as would be apparent to thoseof skill in the art.

The rigidity of the ring relative to the mesh fabric stiffens theimplant, improving handleability particularly when awkward surgicaltools are being used to manipulate the implant. Thus, non-ring shapedframes, such as a criss-crossed arms configuration, would provide thenecessary stiffness although such frames would lack the favorable hoopstrength property of the circular or oval shaped frames.

The frame 14 is preferably attached to the fabric by insert molding. Themesh fabric may be surface treated with a carbon dioxide plasma etchprior to molding which may enhance the union of the mesh and the ringwhen formed from dissimilar materials. Alternatively, the ring and meshmay be ultrasonically welded, heat sealed or adhesively bonded. Theframe may be overlayed onto a surface of the mesh fabric or may bejoined to the fabric edges.

The fabric 12 preferably is formed of a sheet of knitted polypropylenemonofilament mesh fabric such as Marlex® mesh available from C. R. Bard,Inc. When implanted, the polypropylene mesh stimulates an inflammatoryreaction which promotes rapid tissue ingrowth into and around the meshstructure. Alternatively, other surgical materials which are suitablefor tissue reinforcement and/or defect closure may be utilized includingProlene®, Merselene®, Dacron®, Teflon® textile based meshes, microporouspolypropylene sheeting (Celgard®), and expanded PTFE (Goretex®).Absorbable meshes, including polyglactin (Vicryl®) and polyglycolic acid(Dexon®), may be suitable for applications involving temporary repair offascial defects. It also is contemplated that the mesh fabric may beformed from monofilament or multifilament yarns and that woven, moldedand other recognized methods of forming prosthetic mesh materials wouldbe suitable.

Non-tissue infiltratable fabrics also may be supported by thering-shaped frame. Silicone elastomer sheeting, such as Silastic® RxMedical Grade Sheeting (Platinum Cured) distributed by Dow CorningCorporation, would be suitable. The silicone elastomer sheeting may bereinforced with Dacron® or other reinforcing materials. It iscontemplated that oxidized, regenerated cellulose (Intercede(TC7)) alsomay have applications in the present invention.

The ring 14 may be formed from a polypropylene material or a siliconematerial. Other semi-rigid materials which are stiffer than the meshfabric yet sufficiently pliable to be rolled-up in the delivery lumenalso may be suitable. Alternatively, the ring may be formed by hot orcold forming a ring-shaped depression in the mesh sheet. The formedpattern is more rigid than the non-formed body portion of the mesh,providing a stiffer implant with improved handleability. Building up theedges of the body portion with additional mesh material, for example, bysuperposing rings of mesh around the body portion or heat setting foldsof mesh from outlying portions of the fabric, also would increase thedimensional stability of the implant.

The implant 10 may include spaced barbs 22 for preventing migration ofthe implant until tissue infiltration securely anchors the mesh relativeto the rupture site. The barbs grab, pierce or otherwise anchor to thetissue and include a variety of shapes as shown in FIGS. 3(a)-(i). Thebarbs preferably are uniformly spaced about the ring and may beintegrally molded with the ring.

In a representative embodiment, the implant includes a 2.125 inchdiameter circular piece of die-cut Marlex® mesh knit from Marlexpolypropylene monofilament with a 0.006 inch diameter. A 0.030 inchthick and 0.28 inch wide circular polypropylene ring having a 2.125 inchouter diameter and a 1.980 inch inner diameter is insert molded to theMarlex® sheet.

An implant 30 particularly suited for intraperitoneal procedures isillustrated in FIGS. 4(a)-(b) and includes a semi-rigid ring 32, a meshfabric 34 formed of a material which stimulates an inflammatory reactionin tissue after implantation and an adhesion barrier 36 which isolatesthe mesh fabric 34 from sensitive tissues and organs. In anintraperitoneal procedure, the peritoneum 35 is located under theimplant and therefore is not available to provide a biological barrierbetween the implant and the intestine. The barrier layer 36 separatesthe prosthetic mesh 34 from the abdominal viscera, preventing intestinaladhesion and fistulization which may result from an inflammatoryreaction of the bowel and the mesh. A suitable barrier material would bea silicone elastomer, such as Silastic®, which does not substantiallystimulate adhesion formation when implanted in tissue and issignificantly less likely to cause an inflammatory reaction withneighboring tissue than would a prosthetic mesh.

The portions of the Marlex® mesh fabric extending outside the ring formears or anchoring projections 38 through which staples 40 may be drivento secure the implant to the fascia. Stapling of the ears serves thesame function as the antimigration barbs, provisional anchoring of theimplant until full tissue invasion of the prosthetic mesh. The barrierlayer 36 and prosthetic mesh are bonded or sewn to the ring 32. Theedges 41 of the barrier outside of the ring which are not directlyconnected to the underlying mesh or the ring, may be lifted to allowstapling of the anchoring portions 38 to the peritoneum, provisionallyanchoring the implant until sufficient tissue ingrowth holds theprosthesis in place. Upon release, the barrier margin 41 falls back overthe staple and anchoring portions, providing a non-scarifying barrierbetween the implant and the bowel. In an alternative arrangement, thebarrier and mesh may be directly attached with the ring formed alongeither of the mesh or barrier surfaces.

The mesh implants are too large to be inserted through the lumen of atrocar cannula. An instrument 200 for loading the implant into anarrower configuration and then delivering the implant through thetrocar cannula and into the abdominal cavity is illustrated in FIGS.5(a)-(b). By loading the implant at the surgical site, rather thanproviding the implant in a pre-rolled configuration within theinstrument 200, a permanent setting or deformation of the implant isavoided. Such a kinked implant may not seat flush with the abdominalwall and might provide localized areas of weakness which could lead torecurrent herniation.

The loading and delivery instrument 200 includes a main body 202 havinga lumen 204 for receiving and collapsing the implant 205 into a slenderrolled configuration which is advanceable through the lumen of thetrocar cannula. An elongated introducer shaft 206 is rotated, by turninga knurled knob 203, which winds the implant in the lumen into a narrowcylindrical configuration. After the implant is reduced in size, thestepped distal end 207 of the main body is inserted into the proximalend of the previously placed trocar cannula. The proximal end 209 of theelongated shaft (outside of the trocar cannula) is manipulated toadvance the implant from the main body, through the trocar cannula andinto the abdominal cavity. No longer confined by the lumen walls of themain body and the trocar cannula, the implant unfurls into its relaxedflat configuration. Rotating the shaft 206 in the direction opposite theone used in winding should facilitate deployment of the implant.Instruments inserted through additional trocar cannulae may then bemanipulated by the surgeon to position the implant about the herniatedarea.

The main body 202 includes a uniform diameter central lumen 204 which issized to reduce the implant to a predetermined diameter compatible withthe trocar cannula lumen. A cartridge 210 extends from the main body andincludes a floor on which the implant, in the expanded form, is seatedin readiness for loading and delivery, The cartridge 210 may be formedintegral with the main body or may be removably connected thereto. Adoor 220 in the top of the cartridge may be provided for access to theimplant, for example, to check the integrity of the implant. Tabs 211 onthe cartridge floor align the full-sized implant with an opening 212 inthe main body.

The edge of the implant is threaded to a slot 213 at the distal end ofthe shaft which may be tapered to facilitate reception of the edge ofthe implant. A projection may be provided at the base of the slot 213 topinch or grasp the implant, securing the implant and shaft duringinitial rotation. A pin extends from the knob 203 into a longitudinalgroove in shaft 206, imparting rotational movement to the shaft as theknob is turned. An enlarged bulbous tip stabilizes the distal end of theshaft relative to the main body. A cap at the proximal end of the shaftserves as a mechancial stop of forward axial movement.

Premature axial movement of the introducer shaft may produce a helicallywound implant which is too large to travel through the main body or thetrocar cannula. An arrangement for arresting axial movement duringrotation of the shaft is illustrated in FIG. 6. External control threads230 in the shaft 206 are engaged to internal threads 232 in the mainbody 202, limiting forward movement as the implant is wound about theshaft. The number, shape and angle of the threads would vary dependingupon the number of rotations of the shaft necessary to completely windthe implant.

The loading and delivery of the implantable prosthesis is shown in FIGS.7(a)-(c). While the operation of the invention is discussed inconnection with the repair of an indirect inguinal hernia, a similarloading and delivery procedure would be followed for the repair of adirect inguinal hernia and other muscle wall defects. A laparoinflatoris inserted through a small puncture in the abdomen near the navel.Carbon dioxide or other insufflating gas is introduced under pressureuntil the abdominal cavity is sufficiently inflated to allow thesurgical tools to be manipulated relative to the hernia site. A sharppoint of a trocar is used to form an opening through the distendedabdominal wall. The trocar is withdrawn, leaving a hollow trocar cannula300 in the newly formed passageway. A 45° laparoscope is insertedthrough the cannula and is connected to a television monitor whichallows the surgeon to view the interior of the abdominal cavity and toassess the location, type and size of the defect. Additional cannulaeare inserted through bilateral punctures in the abdominal wall. Graspersand electrocautery tools are manipulated through these cannulae todissect the hernia sac, if indicated, and to prepare the hernia site forthe implant.

A loading and delivery tool 302 carrying a suitably sized implant isremoved from its sterilized packaging. The reduced diameter distal endis inserted into one of the previously emplaced trocar cannula. Rotationof the shaft draws the expanded flat implant from the cartridge into themain body lumen where it becomes wrapped around the shaft surface. Thecollapsed implant is guided towards the abdominal cavity by advancingthe proximal end of the elongated shaft. The implant reverts to itsexpanded configuration upon exiting the trocar cannula. Instruments aremanipulated by the surgeon to position the ring of the implant aroundthe opening of the defect. A grasper or other tool may be used to pressthe ring against the muscle, securing the antimigration barbs to thehealthy tissue surrounding the rupture. The inherent hoop strength ofthe implant prevents the mesh portion from collapsing into the void.Tissue growth through the mesh fabric extending across the opening israpid, particularly when the mesh is formed of a material whichstimulates an inflammatory reaction with tissue. In a matter of days, ifnot hours, tissue infiltration of the mesh secures the implant in place,repairing the herniated defect.

The present invention therefore provides an implantable prosthesis and amethod and device for loading and delivering the prosthesis, amongstwhich are certain of the following advantages. The mesh implants providean effective means for repairing an indirect or direct inguinal herniaby occluding the opening of the defect without requiring that the entirevoid be filled. The pliable prosthesis is rollable into a configurationwhich is small enough to be inserted through a laparoscopic cannula, yetis sufficiently resilient to revert to the normal expanded configurationwhich is required to evenly cover the herniated site. The increaseddimensional stability of the implant enhances handleability of the meshfabric during laparoscopic surgery. The delivery tool provides a simpleand quick system for loading and delivering the implant to the abdominalcavity at the surgical site.

It should be understood that the foregoing description of the inventionis intended merely to be illustrative thereof and that otherequivalents, embodiments and modifications of the invention may beapparent to those skilled in the art.

We claim:
 1. An implantable prosthesis for occluding the opening of a tissue or muscle defect, said implantable prosthesis being deliverable to a surgical site through a cannula and comprising:a pliable implantable mesh fabric having a plurality of interstices constructed and arranged to allow tissue ingrowth so that said implantable mesh fabric becomes secured to neighboring tissue after implantation, said implantable mesh fabric including a body portion constructed and arranged to cover the defect opening when positioned thereagainst; and a ring of implantable material integrally attached to said body portion, said implantable ring being stiffer than said body portion of said implantable mesh fabric, said implantable mesh fabric and said integrally attached ring being rollable into a slender cylinder prior to delivery and then delivered through the cannula to the surgical site.
 2. The implantable prosthesis recited in claim 1 wherein said implantable prosthesis has a sufficient hoop strength to limit the deflection of said body portion when said implantable ring is positioned relative to the tissue or muscle defining the defect opening.
 3. The implantable prosthesis recited in claim 1 wherein said pliable implantable ring is formed of a silicone containing material.
 4. The implantable prosthesis recited in claim 1 wherein said pliable implantable ring is formed of a polypropylene containing material.
 5. The implantable prosthesis recited in claim 1 wherein said pliable implantable ring has a substantially rectangular cross-section.
 6. The implantable prosthesis recited in claim 1 wherein said pliable implantable ring includes a circular shape.
 7. The implantable prosthesis recited in claim 1 wherein said pliable implantable ring includes an elliptical shape.
 8. The implantable prosthesis recited in claim 1 wherein said pliable implantable ring includes a polygonal shape.
 9. The implantable prosthesis recited in claim 1 wherein said implantable prosthesis has a flat configuration.
 10. The implantable prosthesis recited in claim 1 wherein said implantable prosthesis has a concave configuration.
 11. The implantable prosthesis recited in claim 1 wherein said implantable prosthesis has a convex configuration.
 12. A laparoscopically implantable prosthesis for occluding the opening of a muscle or tissue defect that is deliverable through a laparoscopic cannula to a surgical site, said implantable prothesis comprising:a sheet of pliable implantable mesh fabric having a plurality of interstices constructed and arranged to allow tissue ingrowth so that the pliable implantable mesh fabric becomes secured to neighoring tissue after implantation, said pliable sheet of implantable mesh fabric stimulating an inflammatory response when implanted in tissue; and a ring of implantable material constructed and arranged to circumscribe the defect opening, said ring being integrally attached to said sheet of pliable implantable mesh fabric and being more rigid than said sheet of pliable implantable mesh fabric, said sheet of pliable implantable mesh fabric and said integrally attached ring being rollable into a slender cylinder prior to delivery and then delivered through the cannula to the surgical site.
 13. The implantable prosthesis recited in claim 12 wherein said implantable prosthesis has a sufficient hoop strength to limit the deflection of said sheet of pliable implantable mesh fabric into the defect opening when said ring of implantable material is positioned relative to the tissue or muscle defining the defect opening.
 14. The implantable prosthesis recited in claim 12 wherein said pliable implantable mesh fabric which stimulates an inflammatory response when implanted in tissue includes a knitted polypropylene monofilament mesh material.
 15. The implantable prosthesis recited in claim 12 further including a pliable flat sheet of barrier material which does not substantially stimulate the formation of postoperative adhesions, said pliable flat sheet of barrier material and said pliable implantable mesh fabric being supported in a face-to-face relationship.
 16. The implantable prosthesis recited in claim 15 wherein said pliable flat sheet of barrier material and said pliable implantable mesh fabric are attached along opposing surfaces.
 17. The implantable prosthesis recited in claim 15 wherein said substantially circular implantable ring is disposed between said pliable flat sheet of barrier material and said pliable implantable mesh fabric.
 18. The implantable prosthesis recited in claim 17 wherein said pliable flat sheet of barrier material and said pliable implantable mesh fabric are attached to said substantially circular implantable ring.
 19. The implantable prosthesis recited in claim 18 wherein the perimeter of said pliable flat sheet of barrier material is larger than the perimeter of said pliable implantable mesh fabric.
 20. A laparscopically implantable prosthesis for occluding the opening of a muscle or tissue defect that is delivered through a laparoscopic cannula to a surgical site, said implantable prosthesis comprising:a pliable implantable non-hollow sheet of mesh fabric having a plurality of interstices constructed and arranged to allow tissue ingrowth so that the pliable implantable sheet of mesh fabric becomes secured to neighboring tissue after implantation, said pliable implantable sheet of mesh fabric having a body portion constructed and arranged to cover the defect opening and a peripheral portion circumscribing said body portion which is stiffer than said body portion, said implantable non-hollow sheet including said stiffer peripheral portion being rollable into a slender cylinder prior to delivery and then delivered through the cannula to the surgical site.
 21. A laparoscopically implantable prosthesis for occluding the opening of a muscle or tissue defect that is delivered through a laparoscopic cannula to a surgical site, said implantable prosthesis comprising:a single sheet of pliable implantable mesh fabric having a plurality of interstices constructed and arranged to allow tissue ingrowth so that the pliable implantable sheet of mesh fabric becomes secured to neighboring tissue after implantation, said pliable implantable sheet of mesh fabric having a body portion constructed and arranged to cover the defect opening and a peripheral portion circumscribing said body portion which is stiffer than said body portion, said single sheet of implantable mesh including said stiffer peripheral portion being rollable into a slender cylinder prior to delivery and then delivered through the cannula to the surgical site.
 22. The implantable prothesis recited in claim 1, in combination with a cannula having a lumen extending therethrough that is adapted to receive and to deliver said implantable prothesis to the surgical site, wherein said implantable mesh fabric and said integrally attached ring are rolled into a slender cylinder and disposed in the lumen of said cannula.
 23. The implantable prothesis recited in claim 1, consisting essentially of said implantable mesh fabric and said integrally attached ring.
 24. The implantable prothesis recited in claim 1, wherein said implantable mesh fabric and said integrally attached ring are completely rollable into a slender cylinder about an axis that extends across a width of said body portion.
 25. The implantable prothesis recited in claim 12, in combination with a cannula having a lumen extending therethrough that is adapted to receive and to deliver said implantable prothesis to the surgical site, wherein said implantable mesh fabric and said integrally attached ring are rolled into a slender cylinder and disposed in the lumen of said cannula.
 26. The implantable prothesis recited in claim 12, consisting essentially of said implantable mesh fabric and said integrally attached ring.
 27. The implantable prothesis recited in claim 15, consisting essentially of said implantable mesh fabric, said integrally attached ring and said pliable flat sheet of barrier material.
 28. The implantable prothesis recited in claim 12, wherein said implantable mesh fabric and said integrally attached ring are completely rollable into a slender cylinder about an axis that extends across a width of said sheet of pliable implantable mesh fabric.
 29. The implantable prothesis recited in claim 20, in combination with a cannula having a lumen extending therethrough that is adapted to receive and to deliver said implantable prothesis to the surgical site, wherein said body portion and said stiffer peripheral portion are rolled into a slender cylinder and disposed in the lumen of said cannula.
 30. The implantable prothesis recited in claim 20, consisting essentially of said implantable non-hollow sheet of mesh fabric.
 31. The implantable prothesis recited in claim 20, wherein said body portion and said stiffer peripheral portion are completely rollable into a slender cylinder about an axis that extends across a width of said body portion.
 32. The implantable prothesis recited in claim 21, in combination with a cannula having a lumen extending therethrough that is adapted to receive and to deliver said implantable prothesis to the surgical site, wherein said body portion and said stiffer peripheral portion are rolled into a slender cylinder and disposed in the lumen of said cannula.
 33. The implantable prothesis recited in claim 21, consisting essentially of said single sheet of pliable implantable mesh fabric.
 34. The implantable prothesis recited in claim 21, wherein said body portion and said stiffer peripheral portion are completely rollable into a slender cylinder about an axis that extends across a width of said body portion. 